With over 60 million low-income individuals covered, Medicaid is the largest public health insurance program in the United States. Medicaid is substantially impacted by the Affordable Care Act and is likely to increase in importance. However, because of the unique structure of Medicaid – a program administered by states within broad federal rules and joint federal-state financing – understanding the Medicaid program often requires a clear understanding of the interaction between federal and state constraints.

Dentons has the specialized expertise and experience necessary when dealing with the Medicaid program. Our lawyers and professionals have worked with Medicaid programs in well over half of the states and have extensive experience representing many different types of companies with interests in the Medicaid program. Our lawyers and professionals have extensive contacts with regulators at both the federal and state levels and have worked with a broad range of parties interested in Medicaid issues, including providers, health plans, large physician practices, pharmacy chains, pharmaceutical benefit managers, and consultancies.

When Medicaid issues require a clear understanding of what the complicated combination of federal and state requirements permit, Dentons’ experts can efficiently provide clear and knowledgeable guidance.

Insights

CMS Releases Proposed Revisions to Medicaid Managed Care Rules

May 4, 2023

On May 3, 2023, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule in the Federal Register titled Medicaid Program: Medicaid and Children's Health Insurance Program Managed Care Access, Finance, and Quality (Proposed Rule).

HHS reminds hospitals that abortions must be provided when needed, regardless of potential state law conflicts

July 12, 2022

United States: On Monday, July 11, 2022, Department of Health and Human Services (HHS) Secretary Xavier Becerra sent a letter to all hospitals and health care providers reminding them of their obligation to comply with the Emergency Medical Treatment and Labor Act (EMTALA).

CMS proposes further changes to Stark Law regulations: ICA definition and unit-based compensation could be drastically affected

July 21, 2021

In a December 2, 2020 rulemaking (2020 Final Rule), the Centers for Medicare & Medicaid Services (CMS) finalized the most sweeping and significant revisions in over a decade to the regulations implementing the federal physician self-referral statute (Stark Law). The bulk of the new regulations took effect earlier this year on January 19, 2021. CMS is now proposing an additional set of modifications to the Stark Law regulations (Proposed Rule). The proposed modifications are scheduled to be published in the Federal Register on Friday, July 23, 2021, and comments on the Proposed Rule are due on or before Monday, September 23, 2021, at 5:00 p.m. ET. The two most significant changes being proposed relate to the definitions of the terms, “indirect compensation arrangement” (ICA) and “unit-based” compensation.

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